Relationship Between Left Ventricular Diastolic Function And Cardiorespiratory Fitness In Patients With Chronic Coronary Syndrome

Objective:Cardiopulmonary fitness（CRF）is closely related to the prognosis of patients with chronic coronary syndrome（CCS）.However,based on the current development of cardiopulmonary exercise test（CPET）,which is an accurate examination to evaluate CRF,not every CCS patient can evaluate CRF in time through CPET.Researches had indicated that the reduced diastolic function of left ventricular existed earlier than the systolic dysfunction of left ventricular in patients who had been suffering from the coronary heart disease.And there was a certain relationship between diastolic function and exercise capacity.Therefore,the goal of this research is to research the relevancy between the diastolic function of left ventricular and CRF in CCS patients.Methods:143 patients who had completed CPET from January 2018 to March 2021 were picked into our research.all the patients’clinical data were gathered.We delimited all the patients into non coronary heart disease group and CCS group in view of the disease diagnosis standard.Then the clinical data were analyzed between the two groups.Patients who were diagnosed with CCS were cut into three groups by the Peak MET results measured by CPET,that were low CRF group（Peak MET<5 METs）,medium CRF group（5.0 METs≤Peak MET<7.0 METs）and high CRF group（Peak MET≥7.0 METs）.Binary logistic regression was applied to analyze the relevance between the diastolic function and reduced CRF in CCS patients.Then we divided CCS patients into three groups in the light of tri-sectional quantiles of E/e’,which was the ratio of peak E-wave velocity to peak mitral annular velocity.Among all of the CCS patients,the relevance of E/e’and other clinical indicators were proved by Spearman rank correlation.At last,the diagnostic value of E/e’for CRF reduction were estimated by the receiver operating characteristic（ROC）curve.Results:1.The average age,the proportion of taking beta blockers and statins were higher in the group of patients who were without non coronary heart disease than those in the CCS group（all P<0.05）.There were lower levels in total cholesterol and lower low density lipoprotein cholesterol in the group of CCS patients than that in the group of patients who were without non coronary heart disease due to the higher proportion of taking lipid-lowering medicines（all P<0.05）.the e’velocity of lateral annulus（Lateral e’）in CCS group was significantly lower than that in non coronary heart disease group（P<0.05）.E/e’in CCS group was significantly higher than that in non coronary heart disease group（P<0.05）.When compared the results of CPET,we found that the indexes of the peak oxygen uptake（Peak VO₂/HR）,peak oxygen uptake（Peak VO₂）,Peak MET,slope of oxygen uptake efficiency（OUES）were lower in the CCS group（all P<0.05）.The slope of carbon dioxide ventilation equivalent（VE/VCO₂slope）was higher in CCS group（P<0.05）.There was no significant diversity in other parameter s between the two groups.2.The average age of patients with CCS in the low CRF group was higher than that in the medium and high CRF groups（all P<0.05）.Meanwhile the proportion of old myocardial infarction was also higher in the low CRF group（P<0.05）.the e’velocity of septal annulus（Septal e’）in low,medium and high CRF groups increased in turn（P<0.05）;Lateral e’in high CRF group was significantly higher than that in low and medium CRF groups（P<0.05）;the E/A which was the ratio of peak E-wave velocity（E）and peak A-wave velocity（A）in high level CRF group was significantly higher than that in low CRF group（P<0.05）;E/e’was significantly higher in the low CRF group than that in the medium and high CRF group（P<0.05）.Peak VO₂/HR、Peak VO₂、OUES showed an increasing trend in the low,medium and high CRF groups（all P<0.05）;VE/VCO₂slope in low,medium and high levels of three CRF groups showed a decreasing trend（P<0.05）.3.E/e’（OR=1.311,95%CI:1.050～1.637）and age(OR=1.084（95%CI:1.024～1.148）were independent hazard factors for CRF reduction in CCS patients（all P<0.05）.4.There were significant differences in Peak VO₂/HR、Peak VO₂、Peak MET、OUES among group one（E/e’<9.0）,group two（9.0≤E/e’<10.8）and group three（E/e’≥10.8）（all P<0.05）;There was no significant difference in VE/VCO₂slope among the three groups（P>0.05）.Peak VO₂/HR、Peak VO₂、Peak MET、OUES in group three were significantly lower than those in group one（all P<0.05）.5.E/e’had positive relevance with female（r=0.235）and age（r=0.278）in CCS patients（all P<0.05）.6.The area under the ROC curve of E/e’to forecast CRF reduction in CCS patients was0.704（95%CI:0.594～0.813,P<0.05）.When E/e’was 9.63,the sensitivity was 84.4%,the specificity was 54.2%.Conclusion:1.The left ventricular diastolic function and the CRF levels of CCS patients were lower than that of non coronary heart disease patients.2.The left ventricular diastolic function of CCS patients was also decreased when CRF was decreased.3.Among the parameters reflecting left ventricular diastolic function such as Septal e’,Lateral e’,E,A,E/A and E/e’,only E/e’was proved to be an independent hazard factor for CRF reduction in patients with CCS.In addition,E/e’had a good predictive value for the decrease of CRF in patients with CCS.4.in CCS patients,E/e’had positive relevance with female and age.